1962726505 NPI number — BELDER ADVANCED MEDICAL LLC

Table of content: (NPI 1962726505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962726505 NPI number — BELDER ADVANCED MEDICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELDER ADVANCED MEDICAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962726505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4122 ROUTE 516
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MATAWAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07747-7022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-264-1163
Provider Business Mailing Address Fax Number:
732-264-3580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4122 ROUTE 516
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATAWAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07747-7022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-264-1163
Provider Business Practice Location Address Fax Number:
732-264-3580
Provider Enumeration Date:
03/25/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BELDER
Authorized Official First Name:
OLGA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-264-1163

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MB07299600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)